The Institute for Nursing Centers and the Alliance of Chicago propose to study the effectiveness of a partnership that shares resources, and utilizes a data-driven approach to promote full clinician use of an EHR in three nurse managed health centers and three community health centers in order to improve the quality of care in areas of preventive care, chronic disease management, and medication management for vulnerable populations. These partners have a track record of highly productive research, successful EHR implementation, commitment to data-supported high quality health care for vulnerable populations, and a history of building and maintaining strong collaborations. The goals of this project address one of the key problems in leveraging health IT to support high quality patient care: the fact that despite the promise, clinical decision support is often not used effectively or consistently by clinicians even when an EHR is available. The research design incorporates quantitative and qualitative methods as well as individual and center level analyses. The critical link between full EHR use (including clinical decision support features) and clinical performance and quality outcomes will be examined with rigorous quantitative methodology. Quality indicators chosen are those that the Institute of Medicine has identified as priority areas for improvement, and are also in areas where significant disparities across race, ethnic, and income groups exist. Qualitative methodology will add to the field?s understanding of health center leadership and change management required for successful use of EHR.